As a pulmonologist in Seattle, near where the first case of the new coronavirus was confirmed in the United States last week, I relied heavily on the city’s hospitals, clinics and departments of health to protect our community. And they did so admirably, immediately acting decisively and shrewdly despite the fear and uncertainty that always arises with an invisible biological threat.
Keeping these centers primed and ready means continued investments in medical equipment, personal protective wear and training of personnel so they are capable and effective.
This began with the chief infection control officer at my hospital sending a detailed email to all health care providers within hours of the infected patient arriving at Seattle-Tacoma International Airport. The message told us what personal protective equipment to wear, which tests to order, the best ways to approach treatment and how to employ isolation precautions to minimize the potential for an outbreak. The communication was clear; there was strong coordination with local and state health officials; and mechanisms were in place to seek assistance from the Centers for Disease Control and Prevention for lab testing and treatment guidance as needed.
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Even if you live in a zip code far outside the Northwest, chances are you are also benefiting from a similar rapid-response system. This system was instituted under the Obama administration after the Ebola virus reached American shores from Africa in September 2014 and now operates so seamlessly that it often goes unnoticed. My colleagues and I working on the front lines of our health care system have come to expect this emergency response to be activated rapidly and effectively whenever a new health threat arises.
But unless something changes by May, this emergency response system will be gravely hollowed out, deprived of the $70 million in funding it was infused with in 2015 during the federal government’s bipartisan response to the Ebola outbreak the year before. Instead, Congress is considering a far more scaled-down version that won’t be nearly as comprehensive, focused on maintaining only a few advanced care facilities nationwide that could treat patients infected with these types of diseases. This reduction in preparedness makes no sense and puts Americans needlessly at risk.
This money has until now ensured that nearly every emergency department and hospital across the country have processes in place to screen for and initially respond to cases that have outbreak potential such as the coronavirus, which originated in Wuhan, China, in December. That means if you’re experiencing symptoms like the one associated with the epidemic (fever, body aches, a dry cough), you’ll likely be tested for the disease or transferred to an assessment center close by that is resourced to do so.
At least 60 such centers exist nationwide to contend with complex diseases that can transform into outbreaks. Keeping these centers primed and ready means continued investments in medical equipment, personal protective wear and training of personnel so they are capable and effective. Medical readiness, just like military readiness, costs money.
Yet our Homeland Security agenda doesn’t seem to reflect the urgency of this issue. Right now we’re haggling over renewing the $70 million allocation that went to upgrading our hospital infrastructure, while President Donald Trump is pushing the construction of a wall along the southern border that would cost upward of $12 billion. The wall is justified by the administration as needed to bolster defense of the homeland — which is clearly threatened any time a major potential outbreak breaches our borders.
If maintaining a strong homeland health defense is now a heavy political lift, it’s not surprising that the administration has little interest in investing in staunching health threats abroad. Just 0.19 percent of the U.S. budget goes toward pandemic preparedness overseas. Yet any money that we do spend means we mitigate the risk of facing outbreaks at home.
For context, 22 countries have given to the World Health Organization’s Contingency Fund for Emergencies, specifically aimed at rapidly providing funds to support response efforts to global health emergencies. In 2019, these contributions totaled approximately $136 million. What’s America’s part of that pie? Nothing.
Unless hospitals and providers are given the necessary financial resources, Americans may soon be more vulnerable to threats like Ebola and coronavirus.
A National Academy of Medicine commission was tasked with studying existing financial shortfalls in pandemic preparedness in the wake of the 2014 Ebola outbreak. This commission identified a need for almost $4.5 billion annually to bolster global preparedness — beyond what the U.S. spends domestically — to prevent the next infectious disease outbreak.
Obviously, we are far short of this financial goal. And it’s not just inadequate funding that keeps us behind. Two high-profile global health security experts departed the administration in 2018, diminishing the chances that leadership from within may change these dangerous realities. Which means that unless hospitals and providers are given the necessary financial resources, Americans may soon be more vulnerable to threats like Ebola and coronavirus that pay no attention to politics or budgetary cycles but which demand a health system ready and primed to respond.